Q: After myocardial infarction which modality of transthoracic echo (TTE) is preferred to detect left ventricular thrombus?
Many hospitals electronic system order TTE as non-contrast by default. The teaching point of this question is to highlight the addition of contrast to TTE.
Although the specificity of both non-contrast and contrast TTE is almost 100% to detect LV thrombus, the sensitivities are way low. The sensitivity to detect LV thrombus with non-contrast TTE is only 35 percent despite it is a thrombus, which is expected to be easily visualized. Adding contrast increases it up to 64 percent.
Srichai MB, Junor C, Rodriguez LL, et al. Clinical, imaging, and pathological characteristics of left ventricular thrombus: a comparison of contrast-enhanced magnetic resonance imaging, transthoracic echocardiography, and transesophageal echocardiography with surgical or pathological validation. Am Heart J 2006; 152:75.